Keep a suspected fracture supported and still; do not attempt to straighten it yourself

Cost: No monetary cost for simple support such as a board, rolled magazine or clothing. Place cloth between the skin and a cold pack.

In plain language: Being able to stand or move does not rule out a fracture. Support the injured part in its current position and minimize movement. The source describes cold application for no more than 20 minutes at a time. Do not straighten the injury yourself or push exposed bone back inside. An initially normal X-ray does not rule out every fracture; follow the clinician's instructions about reassessment or further imaging.

Guidance described by the source: The IFRC 2025 first-aid guidelines describe limb injuries as potentially fractured when uncertain, and immobilization as a way to reduce movement and pain. Cold application should not exceed 20 continuous minutes because longer exposure can injure skin. Femoral and other long-bone injuries can involve life-threatening bleeding. Severe pain or swelling, shock signs, suspected femoral fracture or obvious abnormal limb position warrant emergency assistance. The source describes field realignment only where a trained responder is present and exceptional remote or resource-limited circumstances involve a cold or pale limb below the angulation, or inability to immobilize for evacuation. This is not an instruction for an untrained reader to perform it. Open fractures require bleeding control and infection prevention.

Further imaging described by the source: NICE recommends MRI when hip fracture remains suspected despite normal X-rays, with CT considered if MRI is unavailable within 24 hours. For suspected scaphoid fracture, NICE describes considering MRI first after careful clinical examination. A Cochrane review says initial radiographs cannot exclude scaphoid fracture; among studied patients with negative X-rays and continuing clinical suspicion, the median proportion with a fracture was 20%. ACR knee-trauma criteria describe MRI as usually appropriate after negative X-rays when an occult fracture or internal injury remains suspected, including meniscal and ligament injury.

Source author's evidence grade: B; not site verification or professional approval.

Notes: The source describes accepted practice with limited direct evidence for some prehospital measures. Femoral traction splinting was supported by one retrospective record review of very low certainty, showing less transfusion within 24 hours and shorter admission but unclear mortality or complication differences. It found no evidence establishing whether realignment before immobilization is better than immobilization in the existing position. The source cautions that walking does not exclude fracture, recommends cold rather than heat or alternating applications initially, and rejects trying to walk off a sprain. See chapter 2, entry 1 for smoking cessation, chapter 6, entry 30 for the limits of calcium or bone broth after fracture, this chapter's entry 2 for moving an older person after a fall, and entry 11 for a swollen leg after casting or bed rest. Disability assessment and certification are discussed in chapter 24, entries 9 and 10.

Original source bibliography (titles retained as supplied): International Federation of Red Cross and Red Crescent Societies (2025). International First Aid, Resuscitation and Education Guidelines 2025，第 301–302 页. https://www.ifrc.org/sites/default/files/2026-03/IFRC%20International%20First%20Aid,%20Resuscitation%20and%20Education%20Guidelines%202025.pdf；National Institute for Health and Care Excellence (2011). Hip fracture: management. NICE guideline CG124，第 1.1.1 条. https://www.nice.org.uk/guidance/cg124/chapter/Recommendations；National Institute for Health and Care Excellence (2016). Fractures (non-complex): assessment and management. NICE guideline NG38，第 1.2.3 条. https://www.nice.org.uk/guidance/ng38/chapter/Recommendations；Mallee WH 等 (2015). Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010023.pub2；Taljanovic MS 等, Expert Panel on Musculoskeletal Imaging (2019). ACR Appropriateness Criteria: Acute Trauma to the Knee，Variant 3. American College of Radiology. https://acsearch.acr.org/docs/69419/Narrative/